Archive for June, 2014

Dialysis, internal medicine/pediatrics and nephrology are among the top five specialties to adopt the use of electronic health records (EHRs), according to a new infographic from Berkeley School of Information.

This infographic also shows EHR adoption by site ownership and state, as well as current and future EHR trends and statistics.

Want to know more about EHRs and other healthcare technology trends? 2013 Healthcare Benchmarks: Telehealth & Telemedicine is packed with actionable new information from more than 125 healthcare organizations on their utilization of telehealth & telemedicine. This 60-page report, now in its third year, documents trends and metrics on current and planned telehealth and telemedicine initiatives and includes a year-over-year comparison of telehealth trends from 2009 to present.

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Eighty-three percent of healthcare organizations use cloud services. The top reasons healthcare organizations adopt cloud services is a reduction in maintenance costs, increased speed of deployment and addressing staffing challenges, according to a new infographic from HIMSS.

This infographic also identifies the challenges, barriers and successes healthcare organizations are having with cloud services.

Remote monitoring is another crucial healthcare technology utilized by organizations to obtain patient information and reduce costs. 2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

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Consultations and referrals have long been a source of frustration for physicians and specialists; physicians refer patients to specialists without the necessary tests or pre-work, or a physician refers a patient to a specialist, but hears nothing back from that specialist, says Robert Krebbs, director of payment innovation at WellPoint, Inc. There needs to be better, effective communication between the two, and established processes for consultations and referrals between physicians and specialists to ensure “healthy handoffs,” a key component of care coordination.

Care coordination is important to us and is the main pillar of our Patient-Centered Specialty Care program. What we mean by that is that care coordination is about effective communication. Practices need to establish communication timeliness expectations, agree on core default patient information regardless of the condition, and make sure the information flows back and forth between the two practices that are exchanging the patient or experiencing the care transition for that patient.

We actually refer to those as ‘healthy handoffs.’ That’s what we’re shooting for, care exchanges in which the patient moves between practices in a healthy fashion and everything moves back and forth between the practices in an ideal and efficient manner. It’s about establishing data exchange; that is, how is the information going to get back and forth between two practices?

Every practice is different. Every practice has different capabilities in terms of data exchange. We’re looking for practices to make sure that they understand each other’s capabilities so there are no assumptions to cause missed care opportunities for patients.

It’s about establishing processes for requests in consultations and referrals in the first place and expectations around interactions related to those referrals. It’s about agreeing on the types of consultations that are available: face to face, phone, e-mail from patient to provider. It’s making sure that the entire landscape of consult or referral is clear for both parties.

Health insurers are adopting single-insurer exchanges over multi-insurer private exchanges, at 56 percent and 32 percent respectively, according to a new infographic from Array Health.

This infographic also identifies future health insurance trends, target populations, requirements for a successful exchange and what has changed from 2013 to 2014.

Narrow Network Strategies and Trends for Health Plans and PBMs outlines the tactics health plans are using to restrict medical and pharmacy networks while still maintaining adequate access to care and positive relationships with providers. It also summarizes case studies of health plans and PBMs that have formed narrow networks and the results they’ve seen.

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Providers in a physician practice are a good starting point for case managers to identify high-risk or high-cost patients for case management, explains Annette Watson, RN-BC, CCM, MBA, senior VP of community transformation for Taconic Professional Resources (TPR).

The process of identifying high-risk, high-cost patients can be formal or informal. You can use internal sources; when TPR goes in, that is one of the baselines of understanding. We understand who the patients are and what the population is, because if they have not been using data or have not been in an Advanced Primary Care initiative, it is highly unlikely the practice will have a quantitative method in place when we arrive.

We begin by asking the practice providers who the sickest patients are. Second, we can use data available at the practice level, such as registries or reports that can be run from the EHR.

Third, we also look at the kind of data they get from external sources. For example, do they receive reports from payors that show some utilization activity? Many of those reports may be somewhat aged. They are not necessarily timely, which raises actionability questions. However, we found there are reports coming out from payors, particularly about recent ER use or hospital discharges, that are more timely, which allow the practices to look at datastill retrospectively in most cases but much more quickly than they were able to in the past.

And finally, hospital admission and discharge information is important. Depending on the model in a PCP, if a physician is not the admitting physician that is, if the admission is from a specialist, hospitalist, or through the ERit cannot be assumed the PCP has the admission and discharge information.

People may think physicians know about their patients being in the hospital, but that is not always the case.

(Note: Taconic Professional Resources offers professional training and practice optimization to organizations aspiring to become a patient-centered medical home and/or join a medical neighborhood.)

Having established a firm foundation over two decades of patient-centered care, the patient-centered medical home (PCMH) model is poised for renovation, expanding into medical neighborhoods and opening the door to specialists’ enhanced role in care coordination, according to a new infographic from the Healthcare Intelligence Network.

Want to know more about patient-centered medical homes? 2014 Healthcare Benchmarks: The Patient-Centered Medical Home, a 40-page report now in its seventh year, is designed to meet business and planning needs of physician practices, clinics, health plans, managed care organizations, hospitals and others by providing critical benchmarks in medical home implementation and results.

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Nearly 60 percent of individuals want Congress to improve the Affordable Care Act (ACA) rather than repeal it, according to a new infographic produced by the Journal of the American Medical Association.

This infographic also illustrates the barriers to obtaining health insurance, and the effects of the ACA since its rollout in 2010.

Want to know more about healthcare trends and effects of reform? Plunkett’s Health Care Industry Almanac 2014 provides a complete market research report, including forecasts and market estimates, technologies analysis and developments at innovative firms. This resource provides vital insights into how the healthcare industry is evolving and effects of healthcare reform.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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One step John C. Lincoln network took to improve performance results at the end of its first year as a Medicare Shared Savings Program accountable care organization (MSSP ACO) was to focus on a relatively small number of patients, the top 5 percent of beneficiaries by claims volume who actually account for about 60 percent of medical spend, explains Heather Jelonek, CEO for ACOs at John C. Lincoln Network, who shares additional strategies here.

First, we decided to institute wellness visits across our health system. We’ve worked with several large third party payors here in the valley where they’re now recognizing the Medicare G-codes for wellness visits. We bring those patients in and get a full survey of what’s been going on with them.

Second, we’re engaging in regular population management. We now have our physicians talking about how often they want to see their patients with diabetes or hypertension or cancer.

Third, we’re also starting to focus on those individuals who are ‘aging in;’ those patients who are about 62½. We’re trying to get them in and get them into a routine, making sure they’ve got A1C scores every quarter and every six months, and have had their flu shots and colonoscopies. We’re hoping a healthier generation of individuals coming into the Medicare program improves the quality outcomes that we’ll see long-term.

Fourth, we’ve developed a standardization for our quality reporting. We’ve looked at the top 5 percent of our beneficiaries by claims volume, who actually account for about 60 percent of our medical spend. We’re hoping that by focusing on a relatively small number of patients, we’ll have a drastic impact on outcomes.

Next, we’re also leveraging our electronic medical record (EMR) to the fullest extent; we’re participating in a number of conversations and baseline studies with EPIC®. They are very interested in seeing what we’ve done with the tool and how we’re making it usable for our ACO reporting.

But the one thing that we will continue to struggle with and continue to dive deeply into is integration opportunities: talking to other communities, looking at health information exchanges (HIE’s) as we’re acquiring a new practice or signing a new community physician onto our ACO  bringing everybody to the table so that we’re all speaking the same language.

Healthcare informatics began in 1949 and has evolved rapidly in the past 65 years. In 2013, nearly three fourths of physicians used tablets to maintain electronic health records (EHRs), according to a new infographic from Adelphi University.

This infographic chronicles the history of healthcare informatics and details the road to healthcare digitization.

Want to know more about new healthcare technology trends? 2013 Healthcare Benchmarks: Telehealth & Telemedicine is packed with actionable new information from more than 125 healthcare organizations on their utilization of telehealth & telemedicine. This 60-page report, now in its third year, documents trends and metrics on current and planned telehealth and telemedicine initiatives and includes a year-over-year comparison of telehealth trends from 2009 to present.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

If recent market data is any indication, employers are gravitating toward narrow networks in greater numbers. For instance, a March 2014 Wells Fargo Insurance survey of more than 70 insurance companies placed narrow networks among the top three employer product innovations in 2014, along with are accountable care organizations (ACOs) and increased wellness programs.

In just one example, Harvard Pilgrim HealthCare this week introduced ElevateHealth℠, a partnership with Dartmouth-Hitchcock and Elliot Health System that is a non-profit, high-performance, defined-network product offering access to premier hospitals and providers in New Hampshire.

With its emphasis on care coordination within the network, ElevateHealth insurance premiums on average offer 10 percent savings compared with Harvard Pilgrim’s similar full-network plans, the insurer said.

And last month, UnitedHealthcare announced it would cut 2 to 4 percent of the physicians in its Medicare Advantage network in some Virginia service areas.

In theory, narrow networksand their close cousins, tiered, tailored and high performance networkssound like a good thing: health insurance products that group providers into tiers based on their cost or efficiency of care, then steer patients to choose these providers through lower premiums or cost sharing.

In practice, however, some consumers served by narrow networks are balking at the difficulty of obtaining appointments with network providers. Earlier this month, the Wall Street Journal reported that insurers in several states are expanding hospital and physician networks for plans sold through the Affordable Care Act’s health insurance exchanges amid gripes from patients and state officials about limited provider choices.

Anthem Blue Cross, Blue Shield of California, Health Net and WellPoint are among insurers that have substantially expanded provider networks in its exchanges, the article stated. And more providers are slated to join Harvard Pilgrim HealthCare’s ElevateHealth’s network beginning in July.

Earlier this year, industry thought leaders analyzed what the proliferation of narrow networks means for healthcare. Steven Valentine, president of The Camden Group, talked about the impact on both providers and consumers.

“First of all, we anticipate an increase in the number of covered lives,” Valentine said during HIN’s annual healthcare trends forecast. “Providers are going to see an increase in patient volumes, especially primary care providers. And especially providers in states that have opted to stay in Medicaid.”

However,” he continued, “Many of the qualified health plans have narrow networks, so patients are probably going to be confused about which doctors are in their networks and probably will shift around until they can find the right place for them.”

Providers in networks with bronze plans will probably have much higher increases in patient volumes, he predicted. “And other providers will probably see some shifting until patients can figure out where they need to go.”

Regardless of the confusion, Valentine expects the trend of narrow networks to continue. “We clearly see narrow networks operating in conjunction with tiered benefit plans; that is, a lower premium, a more narrow network. We’ve clearly seen that in some of the exchanges as we look at the various medal options that are available. Narrow networks are here to stay; they are not going to go away.”

Catherine Sreckovich, managing director in the healthcare practice at Navigant, concurs. “I agree 100 percent. We’re going to see [narrow networks] more and more. And to the extent there continues to be competition in the exchanges and more health plans trying to get involved, this trend will continue.”

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